crossing96/oncoscreening huggingface dataset:
Urothelial carcinoma with abundant myxoid stroma.	Urothelial carcinomas with abundant myxoid stroma have thus far been only briefly reported in a couple of textbooks yet not in the peer-reviewed literature. Thirteen cases of urothelial carcinoma with myxoid features were collected over 9 years. Cases with any distinct adenocarcinoma component were excluded from the study. The mean age of the patients was 64 years (range, 45-84 years). Nine of the 13 were male. All cases involved the bladder with one of the cases involving a bladder diverticulum. Treatment included transurethral resection of the bladder only in 6 patients, transurethral resection of the bladder with subsequent intravesical bacillus Calmette-Guérin treatment in 4 patients, radical cystectomy only in 2 patients, and neoadjuvant chemotherapy followed by cystectomy in 1 patient. In all cases, the myxoid stroma was associated with invasive urothelial carcinoma. The 2 most common patterns of cancer with myxoid stroma were small- or medium-sized nests seen in 10 cases followed by filiform cancer seen in 4 cases. Other patterns of invasive cancer associated with myxoid stroma were short cords and individual cells. The percentage of invasive urothelial carcinoma that had myxoid stroma ranged from 5% to 95% (mean, 50%). An unusual finding was the presence of invasive low-grade urothelial carcinoma associated with myxoid stroma in 5 cases, 4 of which had an overlying low-grade papillary urothelial carcinoma component. All cases were uniformly positive for cytokeratin 7 and negative for CDX2 with 5 cases also positive for cytokeratin 20. Urothelial carcinoma associated with the extracellular myxoid matrix was positive for MUC5 in 3 cases and for MUC2 in 2 cases. Two of the MUC5-positive cases were also positive in the urothelium for polyclonal CEA. Histochemical stains for Alcian blue with and without hyaluronidase, periodic acid-Schiff, and mucicarmine showed positivity in the areas of myxoid differentiation. The current study describes a rare variant of urothelial carcinoma that may be confused with primary or secondary adenocarcinoma of the bladder, which can have therapeutic and prognostic implications.	bladder
Cytologic features of primary signet ring cell carcinoma of the bladder: a case report.	BACKGROUND: Signet ring cell carcinoma is a very rare subtype of adenocarcinoma of the urinary bladder. Urine cytology is a useful method for screening and followup of urinary bladder carcinoma. CASE: A 43-year-old woman was referred for evaluation of painless hematuria. Laboratory evaluation showed anemia, hematuria and elevated tumor marker levels. Pelvic computed tomography (CT) demonstrated diffuse wall thickening, and the chest CT suggested metastatic lesions in the lung and hepatic dome. Abdominal CT, esophagogastroduodenoscopy and colonoscopy revealed no evidence of malignancy in the gastrointestinal tract. Cystoscopy revealed very large masses in the anterior and posterior wall of the bladder. Bladder washings, urine cytology and biopsy demonstrated characteristic signet ring cells without foci of urothelial carcinoma or other lesions. Three months later, ascitic fluid was obtained; the results showed signet ring cells identical to those seen in the urine specimen. CONCLUSION: Signet ring cell carcinoma of the urinary bladder can be diagnosed by urinary cytology and confirmed by cystoscopic biopsy.	bladder
Offline adaptive radiotherapy for bladder cancer using cone beam computed tomography.	We investigated if an adaptive radiotherapy approach based on cone beam CT (CBCT) acquired during radical treatment was feasible and resulted in improved dosimetric outcomes for bladder cancer patients compared to conventional planning and treatment protocol. A secondary aim was to compare a conventional plan with a theoretical online process where positioning is based on soft tissue position on a daily basis and treatment plan choice is based on bladder size. A conventional treatment plan was derived from a planning CT scan in the radical radiotherapy of five patients with muscle invasive bladder cancer. In this offline adaptive protocol using CBCT, the patients had 10 CBCT: daily CBCT for the first five fractions and then CBCT scan on a weekly basis. The first five daily CBCT in each patient were used to create a single adaptive plan for treatment from fraction eight onwards. A different process using the planning CT and the first five daily CBCT was used to create small, average and large bladder volumes, giving rise to small, average and large adaptive bladder treatment plans, respectively. In a retrospective analysis using the CBCT scans, we compared the clinical target volume (CTV) coverage using three protocols: (i) conventional; (ii) offline adaptive; and (iii) online adaptive with choice of 'plan of the day'. Daily CBCT prolonged treatment time by an average of 7 min. Two of the five patients demonstrated such variation in CTV that an offline adaptive plan was used for treatment after the first five CBCT. Comparing the offline adaptive plan with the conventional plan, the CTV coverage improved from a minimum of 60.1 to 94.7% in subsequent weekly CBCT. Using the CBCT data, modelling an online adaptive protocol showed that coverage of the CTV by the 95% prescribed dose line by small, medium and large adaptive plans were 34.9, 67.4 and 90.7% of occasions, respectively. More normal tissue was irradiated using a conventional CTV to planning target volume margin (1.5 cm) compared to an online adaptive process (0.5 cm). An offline adaptive strategy improves dose coverage in certain patients to the CTV and results in a higher conformity index compared to conventional planning. Further research in online adaptive radiation therapy for bladder cancer is indicated.	bladder
Detrusor muscle in the first, apparently complete transurethral resection of bladder tumour specimen is a surrogate marker of resection quality, predicts risk of early recurrence, and is dependent on operator experience.	BACKGROUND: An European Organisation for Research and Treatment of Cancer analysis of multicentre trials found significant interinstitutional variability in recurrence rates at first follow-up cystoscopy (RR-FFC) and attributed this to variable transurethral resection of bladder tumour (TURBT) quality. OBJECTIVE: To determine whether resection of detrusor muscle (DM) in the first, apparently complete TURBT is a surrogate marker of quality and whether the presence of DM is dependent on a surgeon's experience. DESIGN, SETTING, AND PARTICIPANTS: Over a 2-yr period, patients with new bladder tumours that were judged to have been completely resected were recruited from our prospectively maintained bladder tumour database. Strict exclusion criteria were applied. MEASUREMENTS: Prospectively recorded tumour size, tumour multiplicity, surgeon category, DM status, grade and stage of tumour, and findings at first follow-up cystoscopy (at 3 mo) and at early re-TURBT were evaluated. Surgeons were stratified into seniors (consultants and year 5 or year 6 trainees) and juniors (trainees lower than year 5). Early recurrence (for calculating RR-FFC) was defined as pathologically confirmed tumour on early re-TURBT or recurrence at the first follow-up cystoscopy. Logistic regression multivariate analyses were carried out to determine associations between variables. RESULTS AND LIMITATIONS: In a total of 356 patients, DM was present in 241 patients (67.7%). Multivariate analyses revealed that large tumours, high-grade tumours, and surgery by senior surgeons was independently associated with the presence of DM in the resected specimens. The RR-FFCs when DM was absent and present were 44.4% and 21.7%, respectively (odds ratio: 2.9; 95% confidence interval: 1.6-5.4; p=0.0002). The absence of DM and resection by less experienced surgeons independently predicted a higher RR-FFC. This association was also seen in small and low-grade tumours. The number of patients in this study appears modest, and further validation may be required. CONCLUSIONS: DM absence or presence in the first, apparently complete TURBT specimen appears to be a surrogate marker of resection quality by independently predicting the RR-FFC, which is also dependent on surgeon experience.	bladder
Sarcomatoid carcinoma of the urinary bladder: a case report with immunohistochemical and molecular genetic analysis.	The author reports a rare case of sarcomatoid carcinoma with an emphasis on immunohistochemical features. A 79-year-old man was admitted to our hospital because of hematuria. An endoscopy revealed a large polypoid tumor in the bladder, and urine cytology demonstrated malignant cells. A cystectomy was performed. The patient is now alive without metastasis 4 months after the operation. Grossly, a large polypoid tumor (5 x 6 x 5 cm) was present in the bladder. Microscopically, the tumor consisted of high-grade transitional cell carcinoma element (10% in area) and sarcomatoid element (90% in area). There was a gradual transition between the two. The tumor cells were invaded into peribladder tissue (pT3b). Immunohistochemically, the sarcomatoid element was positive for four types of pancytokeratins, high-molecular weight cytokeratin (CK), CK5/6, CK7, CK18, CK19, epithelial membrane antigen (EMA), vimentin, p53 protein, p63, Ki-67 (labeling = 92%), neuron-specific enolase (NSE), and platelet-derived growth factor receptor-alpha (PDGFRA). It was negative for CK14, CK20, melanosome, carcinoembryonic antigen (CEA), desmin, S100 protein, myoglobin, alpha-smooth muscle antigen (ASMA), CD34, chromogranin, synaptophysin, CD56, CD68, and KIT. The transitional cell carcinoma element showed similar immunoreactivity except for negative CK5/6, positive CK20, and negative vimentin. A molecular genetic analysis of KIT gene (exons 9, 11, 13, and 17) and PDGFRA (exons 12 and 18) gene with the use of PCR-direct sequencing showed no mutations. The present case is the first report of sarcomatoid carcinoma of the urinary bladder demonstrating extensive immunohistochemistry and mutational status of KIT and PDGFRA genes. The sarcomatoid carcinoma in the present case may be derived from sarcomatous differentiation of high-grade transitional cell carcinoma.	bladder
Bladder cancer.	Bladder cancer is a heterogeneous disease, with 70% of patients presenting with superficial tumours, which tend to recur but are generally not life threatening, and 30% presenting as muscle-invasive disease associated with a high risk of death from distant metastases. The main presenting symptom of all bladder cancers is painless haematuria, and the diagnosis is established by urinary cytology and transurethral tumour resection. Intravesical treatment is used for carcinoma in situ and other high grade non-muscle-invasive tumours. The standard of care for muscle-invasive disease is radical cystoprostatectomy, and several types of urinary diversions are offered to patients, with quality of life as an important consideration. Bladder preservation with transurethral tumour resection, radiation, and chemotherapy can in some cases be equally curative. Several chemotherapeutic agents have proven to be useful as neoadjuvant or adjuvant treatment and in patients with metastatic disease. We discuss bladder preserving approaches, combination chemotherapy including new agents, targeted therapies, and advances in molecular biology.	bladder
[Detection of oncoprotein E7 HPV16 in the cancer and normal urinary bladder urothelium].	Oncoprotein E7 HPV16 was detected by immunohistochemical staining with specific polyclonal antiserum [Fiedler et al., 2004] in 7 out of the 24 (29.2%) studied bladder cancer specimens. The result is in good agreement with the hypothesis that HPVs take part in the carcinogenesis of the urothelium. However, some of the observations made seem rather hard to be interpreted at present. The latter include the detection of E7 HPV16 in a small number of cancer cells in a few bladder cancer specimens being examined; the presence of this protein in the cytoplasm, rather in the cancer cell nuclei, and its detection in some morphologically normal bladder urothelial specimens from non-cancer patients. Thus, the hypothesis that HPVs are implicated in the carcinogenesis of the bladder urothelium deserves further verification.	bladder
Selection of optimal antisense accessible sites of uroplakin II mRNA for bladder urothelium.	The optimal antisense accessible sites (AAS) of uroplakin II (UP II) mRNA, a specific gene expressed in bladder urothelium, were selected in order to provide a novel method for targeted therapy of transitional cell carcinoma (TCC) of bladder. The 20 mer random oligonucleotide library was synthesized, hybridized with in vitro transcripted total UP II cRNA, then digested by RNase H. After primer extension and autoradiography, the AAS of UP II were selected. The RNADraw software was used to analyze and choose the AAS with obvious stem-loop structures, according to which the complementary antisense oligonucleotides (AS-ODN) were synthesized. With the AS-ODN(0) designed only by RNADraw as a control, the AS-ODNs were transferred into UP II highly-expressing cell line RT(4). The cellular expression of UP II mRNA was detected by RT-PCR and Western blot. Twelve AAS of UP II mRNA were selected in vitro. Four AAS with stem-loop structures were chosen, locating at 558-577, 552-571, 217-236 and 97-116 bp of UP II mRNA respectively. After transfection with the corresponding AS-ODN (AS-ODN(1), AS-ODN(2), AS-ODN(3) and AS-ODN(4)) for 18 h, the UP II mRNA levels in RT(4) cells were reduced by 29.3%, 82.7%, 71.3% and 70.9%, while UP II protein levels were decreased by 20.2%, 78.5%, 65.2% and 64.4% respectively, which were significantly higher than those of AS-ODN(0) (14.3%, 12.1% respectively) (P<0.01). The AAS of UP II mRNA was effectively selected in vitro by random oligonucletide library/RNase H cleavage method in combination with computer software analysis, which had important reference values for further studying biological functions of UP II gene and targeted therapeutic strategy for TCC of bladder.	bladder
Influence of body mass index on operability, morbidity and disease outcome following radical cystectomy.	INTRODUCTION: Obesity may influence postoperative outcome after tumor surgery. We evaluated the impact of patients' body mass index (BMI) on peri- and postoperative morbidity and outcome following radical cystectomy for bladder cancer. PATIENTS AND METHODS: 390 consecutive patients who underwent radical cystectomy due to bladder cancer from January 1986 to December 2004 were reviewed. According to WHO criteria, patients were divided into normal weight (NW, 45.6%), overweight (OW, 44.4%) and obese (10.0%) subgroups. The BMI of patients was associated to the time of surgery, amount of intraoperative blood units, TNM stage, postoperative complication rate as well as overall survival. RESULTS: The time of cystectomy increased with the degree of patients' obesity (NW, 330 min; OW, 355 min; p = 0.007). Between NW and OW patients no significant differences were noted in respect to intraoperative blood transfusion rate (NW, 3.0; OW, 2.0; p = 0.47), postoperative TNM stage (pTis-pT2b: 42.6 vs. 48.6%; pT3a-4: 38.2 vs. 27.2%; pN+: 20.2 vs. 24.2%) and postoperative complications, except for postoperative bleeding, which was more common in OW patients (p = 0.02). Mean overall survival times showed no significant differences between NW and OW patients receiving ileal conduits (5-year survival rate: 34.0 vs. 41.1%; p = 0.140) or ileal neobladders (5-year survival rate: 65.1 vs. 70.8%; p = 0.127). CONCLUSIONS: Increased BMI poses a greater challenge for surgical interventions such as radical cystectomy in bladder cancer patients. However, in our series, intra- and postoperative morbidity was not significantly elevated in OW patients. Overall survival was not reduced in OW compared to NW patients. Therefore, elevated BMI is not an exclusion criterion for radical cystectomy in bladder cancer patients.	bladder
Bacillus Calmette-Guérin osteomyelitis mimicking spinal metastasis from urothelial cell carcinoma of the bladder.	A 66-yr-old male presented with progressively worsening back pain 5 mo after undergoing radical cystectomy and bilateral extended pelvic lymph node dissection for bacillus Calmette-Guérin-refractory pTisN0M0 urothelial carcinoma of the bladder. Imaging revealed lytic lesions in the 10th and 11th vertebral bodies of the thoracic spine that were suspicious for metastasis and cord compression. The patient underwent computed tomography-guided biopsy of the abnormalities, which showed no evidence of malignancy but revealed chronic inflammatory infiltrate with cultures positive for Mycobacterium bovis. The patient was treated with isoniazid, rifampin, ethambutol, and pyrazinamide.	bladder
Neoadjuvant versus adjuvant chemotherapy for muscle-invasive bladder cancer.	Muscle-invasive bladder cancer is a deadly disease that often requires more than radical surgery for optimal management. The best level one evidence supports the use of neoadjuvant methotrexate, vinblastine, doxorubicin and cisplatin (MVAC) chemotherapy followed by surgery. There remains controversy, however, with some continuing to argue in favor of selective adjuvant chemotherapy only in the highest risk patients. Certain patients and situations argue in favor of a surgery-first approach, with selective chemotherapy in an adjuvant setting. There is a need for better markers for disease risk and progression in advanced bladder cancer to identify those who would benefit the most from aggressive, multimodal therapy. Further studies are needed to address the ongoing questions that remain in the management of this disease.	bladder
The current classification of urothelial neoplasms.	The classification of urothelial neoplasms has been a subject of significant controversy and debate over the last decade. Only recently has a general level of agreement developed on the utility of the classification first proposed by the World Health Organization and the International Society of Urologic Pathology in 1998. Recent adoption of this scheme in therapeutic guidelines indicates the clinical utility of the system. In this review a brief historical perspective is presented, followed by a review of the classification system, the histological criteria for the specific categories and the clinical significance of these diagnoses.	bladder
Clear cell adenocarcinoma of the urinary bladder: a short review.	In this short review, we discuss clear cell adenocarcinoma of the urinary bladder, a rare tumor that primarily affects women. The histogenesis of this neoplasm is uncertain; in some tumors the clinicopathologic and histologic features are suggestive of a müllerian origin. Clear cell adenocarcinoma consists of cells with abundant clear cytoplasm, arranged in solid, glandular, or tubulocystic patterns. These tumors are positive for pancytokeratin, cytokeratin 7, and CA 125 immunohistochemical stains. Patients typically present with gross hematuria, dysuria, and discharge. The natural history is poorly understood and patient outcomes remain unclear. Currently, surgery is the treatment of choice. Nephrogenic adenoma is the most important differential diagnostic consideration, followed by metastatic clear cell carcinoma.	bladder
Complications following radical cystectomy for bladder cancer in the elderly.	CONTEXT: The incidence of bladder cancer increases with advancing age. Considering the increasing life expectancy and the increasing proportion of elderly people in the general population, radical cystectomy will be considered for a growing number of elderly patients who suffer from muscle-invasive or recurrent bladder cancer. OBJECTIVE: This article reviews contemporary complication and mortality rates after radical cystectomy in elderly patients and the relationship between age and short-term outcome after this procedure. EVIDENCE ACQUISITION: A literature review was performed using the PubMed database with combinations of the following keywords cystectomy, elderly, complications, and comorbidity. English-language articles published in the year 2000 or later were reviewed. Papers were included in this review if the authors investigated any relationship between age and complication rates with radical cystectomy for bladder cancer or if they reported complication rates stratified by age groups. EVIDENCE SYNTHESIS: Perioperative morbidity and mortality are increased and continence rates after orthotopic urinary diversion are impaired in elderly patients undergoing radical cystectomy. Complications are frequent in this population, particularly when an extended postoperative period (90 d instead of 30 d) is considered. CONCLUSIONS: Although age alone does not preclude radical cystectomy for muscle-invasive or recurrent bladder cancer or for certain types of urinary diversion, careful surveillance is required, even after the first 30 d after surgery. Excellent perioperative management may contribute to the prevention of morbidity and mortality of radical cystectomy, supplementary to the skills of the surgeon, and is probably a reason for the better perioperative results obtained in high-volume centers.	bladder
Initial results of bladder preserving approach by chemo-radiotherapy in patients with muscle invading transitional cell carcinoma.	BACKGROUND: This study was conducted to test the efficacy and tolerability of trimodality treatment for invasive bladder cancer and to test the possibility of bladder sparing. METHODS: This study had been carried out on 50 patients with transitional cell carcinoma (TCC) stage T2- T3 tumors with adequate performance status and renal function. All patients were subjected to maximum transurethral resection of bladder tumors (TURBT). Patients were then subjected to chemo-radiation that was executed in two treatment phases. Phase I was external radiotherapy in the form of 46 Gy /23 fractions /5 weeks to whole pelvis with concurrent cisplatin 40 mg/m2 weekly. Phase II was 20 Gy /10 fractions /2 weeks to the bladder tumor with concurrent cisplatin 40 mg/m2 weekly. After phase I, patients who had complete response (CR) or partial response (PR) were subjected to phase II and patients who had stationary disease (SD) were subjected to salvage cystectomy. After the end of treatment, patients who had CR were subjected to bladder preservation. Radiological and cystoscopic reevaluation was done to assess the tumor response after phase I and phase II. After completion of the scheduled treatment, patients were under follow up for clinical examination, radiological, and cystoscopic assessment. RESULTS: The treatment schedule was tolerable and was associated with infrequent incidence of moderate toxicity that was easily controlled without interruption of treatment. Bladder preservation was achieved in 72%of patients. The actuarial relapse free survival and overall survival at a median follow up 18 months for patients who were candidate for bladder preservation were 81% and 100%; respectively. Invasive recurrence (16%) salvaged with cystectomy and superficial recurrence (6%) successfully treated with Bacilles bilie de CalmetteGuerin. CONCLUSIONS: This study indicates that in spite of a relatively small number of patients and short follow-up period; the trimodality treatment could be an effective way to achieve a high response rate in the treatment of invasive TCC of the bladder with good tolerance.	bladder